Background:
Pulmonary vein isolation (PVI) is the standard approach in catheter ablation for atrial fibrillation (AF). Very High-Power Short-Duration (vHPSD) ablation, delivering 90W over 4 seconds using the QDOT MICRO™ catheter (Biosense Webster, Diamond Bar, CA, USA), has been developed to reduce procedure time while ensuring lesion durability and safety. Pulsed Field Ablation (PFA) with the Farapulse™ system (Boston Scientific, Marlborough, MA, USA) is a non-thermal technique based on electroporation, aiming to selectively affect myocardial tissue and spare surrounding structures. While both vHPSD and PFA aim to achieve rapid and durable PVI with minimal collateral damage, head-to-head comparisons in a standardized clinical setting are still lacking.
Objective:
To compare procedure characteristics, safety, and arrhythmia recurrence at 12 months between vHPSD and PFA in patients undergoing first-time ablation for AF using a PVI-only strategy.
Methods:
We retrospectively analyzed 244 consecutive patients with paroxysmal or persistent AF who underwent de novo PVI at a single center between 2021 and 2024. Patients received either vHPSD ablation (90W/4s, QDOT MICRO™, n=155) or PFA using the Farapulse™ system (n=89). Only procedures following a strict PVI-only approach, without additional lines or substrate modification, were included. Baseline characteristics, procedure times, radiation exposure, and complication rates were recorded. Follow-up included regular clinical evaluations and rhythm monitoring over 12 months, excluding a 90-day blanking period. Standard statistical methods were used to compare both groups.
Results:
Baseline characteristics were comparable between groups. Mean procedure time was significantly shorter in the PFA group (48.17 ± 12.78 min) compared to the vHPSD group (75.06 ± 27.01 min, P<0.01). Entry and exit block were achieved in all cases. Major complications were rare and did not differ significantly (0% in PFA vs. 1.29% in vHPSD, P=0.53). Minor complications were also similar (3.37% in PFA vs. 2.58% in vHPSD, P=0.71). Radiation exposure was lower in the vHPSD group (655 ± 536.8 cGy·cm² vs. 949.4 ± 687.9 cGy·cm², P<0.01), as was fluoroscopy time (7.27 ± 4.55 min vs. 11.61 ± 4.54 min, P<0.01). Recurrence rates after 12 months were similar (16.77% in vHPSD vs. 16.85% in PFA, P=0.99). Pulmonary vein reconnection patterns in patients undergoing repeat ablation will be presented at the congress.
Conclusion:
Both vHPSD and PFA are safe and effective for first-time PVI in patients with AF. PFA resulted in shorter procedure times, while vHPSD was associated with lower radiation exposure. Recurrence rates were comparable at one year. Further follow-up will clarify whether these differences affect long-term outcomes.
